Consumers weigh in on top 10 meaningful use arguments

By Molly Merrill
10:24 AM
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A Washington-based advocacy group has collected consumer and employer perspectives on the top 10 arguments concerning meaningful use.  And with only a week left before the public comment period on <a href="/directory/meaningful-use" target="_blank" class="directory-item-link"><a href="/directory/meaningful-use" target="_blank" class="directory-item-link">meaningful use comes to a close, the Office of the National Coordinator for Health Information Technology is urging the public to weigh in with their own thoughts.

While the healthcare provider community's concerns with the government's proposed definition of "meaningful use" of healthcare IT are well-documented in the media, less attention has been paid to the consumer and employer perspectives, said officials of the Consumer Partnership for eHealth or CPeH, a coalition led by the National Partnership for Women and Families.

CPeH is an effort to engage a diverse group of national consumer, patient and labor organizations in the healthcare IT policy debate. The partnership has also launched an online community to promote open communication among members of the group.

CPeH has collected the following responses regarding the most common arguments heard about meaningful use:

1. The proposed meaningful use definition is asking too much, too soon for 2011. It should be scaled back so more providers can focus on simple adoption.

Consumer response: The proposed criteria for meaningful use in 2011 don't ask for capabilities that are beyond those of today's certified EHRs. IT also offers flexibility by allowing providers to choose their starting payment year. The incentives are voluntary; they are not an entitlement and there is no requirement to participate. But for those choosing to leverage public dollars we must ensure the investment pays off in the form of better care.

2. Providers, especially hospitals, need much greater flexibility in the sequencing of the goals and objectives for meaningful use.</strong></p>

Consumer response: As long as the criteria in the both Privacy and Security and Patient Engagement are mandatory, we agree with the HIT Policy Committee's recommendations for additional flexibility by allowing some criteria in some categories to be deferred, while making certain criteria mandatory. Patient engagement criteria require changes that will make the most difference to patients and their families and are not likely to occur without clear incentives for providers.

3. There are too many quality measures proposed, and many criteria require manual recording.</strong>

Consumer response: We agree. However, some quality measures must be retained – both because quality measurement is required by the HITECH Act, and because measurably improving quality is the ultimate meaningful use of healthcare IT. We believe it is important to focus on a core set of exemplary measures that demonstrate providers are using key functions of the EHR, can be collected easily as a byproduct normal workflows, and that show progress in improving health outcomes for patients. Meaningful use criteria should not include measures that necessitate manual recording.

4. Small primary care practices have fewer resources to implement meaningful use as defined in the proposed rule. Therefore those intended to benefit most from these incentives, won't.

Consumer response:
  With federal funds available to help small practices cover the cost of IT systems and with aid from Regional Extension Centers there is greater support for smaller practices. Congress also ensured that eligible Medicaid providers and hospitals can receive funding in their first year for adopting, implementing, or upgrading certified EHR technology so they are able to meaningfully use the technology in their second payment year.<br />

5.The timeline to meet the proposed measures is too aggressive, given that we don't have a single national infrastructure or set of national standards.

Consumer response:
The requirements for year one of the proposed rule are based on the capabilities and standards of today's certified EHR technology. The only area of ambiguity is data exchange, and <a href="/directory/centers-medicare-medicaid-services-cms" target="_blank" class="directory-item-link">CMS is proposing that providers perform one test of their ability to send data to another authorized provider. We believe it is essential to maintain this basic criterion, although we also believe that the data exchange should have to be successful.

6. Implementing computerized physician order-entry (CPOE) is a tremendous task, and adoption levels are very low. Implementation of CPOE must be paced according to individual provider needs, and it is unreasonable to require criteria related to CPOE before 2015.

Consumer response: CPOE is a foundational tool necessary to provide the most effective,
appropriate care for patients. Without CPOE, providers can't take advantage of all of the functionalities of an EHR system, such as reminders for follow up care, clinical alerts and decision support. Hospitals would be required to use CPOE for just 10 percent of physician orders in Stage 1.

7. Many of the criteria require significant workflow and system changes to incorporate services that are not reimbursed.

Consumer response: While these kinds of activities may not be paid for explicitly under fee-for-service, the meaningful use incentives act as a financial reward for this kind of patient-centered care. This will translate to the kind of better provider-patient relationships and more patient-centered care that providers and patients both want. We can't successfully implement further payment reforms without an underlying healthcare IT infrastructure to connect our fragmented system and report on how providers are performing.

8. Providing patients with access to their health information is too much of an added burden on providers.

Consumer response: If patient health information is available electronically to a provider, it can and should be made available electronically to patients. This is not a burden when designed well, such as when information is accompanied by education and resource materials that help consumers understand and use their own information effectively.

9. Collecting structured data on race, ethnicity, preferred language and gender (RELG) is too burdensome for providers.

Consumer response: We need to collect better information about the demographics of patient populations. We hope that in the final rule and succeeding definitions CMS will go further and require the analysis and use of this information to reduce and ultimately eliminate disparities.

10. Forcing providers to implement health IT too rapidly will ultimately harm patients.

Consumer Response: The meaningful use incentive program is voluntary. Patients are already being harmed every day due to the absence of information necessary to provide consistent, high quality care. Patient safety is a top priority for all stakeholders, and work is underway to monitor health IT-related safety issues.

Click here to submit your own comments to the ONC.